UPJ INSIGHT: Influence of Clinical and Sociodemographic Factors on the Management, Costs, and Outcomes of Acute Urinary Retention in the Acute Care Setting
By: Jordan Alger, MD, MS; Om Dave, BS; Kevin Neuzil, MD; Charles D. Scales, Jr., MD, MSHS, FACS; David F. Friedlander, MD, MPH | Posted on: 01 Aug 2022
Alger J, Dave O, Neuzil K et al: Influence of clinical and sociodemographic factors on the management, costs, and outcomes of acute urinary retention in the acute care setting. Urol Pract 2022; 9: 284.
Study Need and Importance
Benign prostatic hyperplasia (BPH) is a common, progressive condition that affects the majority of men over age 50 years. Acute urinary retention (AUR) is a severe sequela of undertreated BPH that impairs quality of life and imposes significant health care costs. Since BPH is often highly treatable, we sought to examine factors associated with the development of AUR in individuals with BPH and their impact on repeated episodes of AUR, subsequent bladder outlet procedures and health care costs.
Figure. Unadjusted episode-based costs for encounters related to urinary retention according to revisit status (A) and procedure status (B).
What We Found
Among over 30,000 patients presenting with AUR and BPH over a calendar year, 17.5% of patients had multiple AUR encounters, yet only 6.4% underwent a bladder outlet procedure that year. Older age, Black race, Medicare insurance and lower education level were associated with repeated AUR episodes. Older age and lower education level were also associated with lower odds of receiving bladder outlet procedures. Health care costs were lower for single encounters vs revisits for AUR, and costs attributed to undergoing a bladder outlet procedure were lower than the costs of forgoing one (see Figure).
Causal inferences are limited due to our study’s retrospective design. In addition, we could not track loss to followup or totally eliminate the influence of confounding diagnoses because of limitations in the data set. The relatively short followup and lack of prior medical history regarding BPH treatment also challenge how the data can be interpreted over longer periods of time. Lastly, our cost calculations utilized cost-to-charge ratios that may not accurately represent true costs.
Interpretation for Patient Care
Sociodemographic factors influence the odds of developing recurrent AUR and the decision to subsequently undergo a bladder outlet procedure for patients with BPH. Considering the increased health care costs associated with repeated AUR episodes and delaying bladder outlet procedures after AUR, this study may serve as a framework for identifying high-risk patients and implementing surgical interventions sooner.